Ligament injuries becoming common

Feb. 10, 2013

Katie Schwegmann holds a basketball while she watches her Miami Redhawks teammates work out Nov. 11, 2002, in Millet Hall at Miami University of Ohio in Oxford, Ohio. Schwegmann was named Miss Kentucky Basketball in high school, but was sidelined due to eight knee surgeries. / Craig Ruttle/Cincinnati Enquirer/GNS

Written by

Janice Lloyd

USA Today

When to return

President of the National Athletic Trainers’ Association Jim Thornton said only a physician should give clearance for a player to return to the playing field after rehab. A national debate ensued over whether Robert Griffin III had returned to play too soon after injuring his ligament several weeks before. “Sometimes these injuries just happen,” Thornton said. “Had he stayed out longer to let the other injury heal, maybe it wouldn’t have happened, but it’s hard to know.” In either case, Thornton said, parents don’t want coaches or athletes to make the decision when to return to action. “When there’s a win on the line, they don’t always have the health of the athlete in mind,” he said.

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Confident you and your teen athlete are both safe from suffering the knee injury that forced NFL quarterback Robert Griffin III off the game field and under the knife recently?

Think again. The Washington Redskins’ rookie tore two of the four primary ligaments, including his anterior cruciate ligament. ACL injuries have more than tripled since 2000, according to the American Academy of Orthopedic Surgeons, and it doesn’t take a hit from a behemoth defenseman to cause one. ACL injuries are the most common knee sprain and result more frequently from noncontact.

“It can happen in any sport that requires you to pivot, turn, twist or jump,” said Jim Thornton, president of the National Athletic Trainers’ Association. “It can even happen on a golf course on uneven terrain or if you’re working in your yard.”

Learning how to protect the knee can eliminate the need for surgery and can help prevent lingering damage that can cause arthritis and lead to knee replacement. Knee replacement surgeries are soaring and expected to continue to rise as active Baby Boomers age.

Braces can support the ligaments on the outside and inside of knees, but will not aid the ACL. That rope-like ligament is in the center of the knee and runs diagonally from the thigh bone to the shin bone.

If walking, jogging, cycling or swimming is your game, you probably can skip surgery, he said. But if you want to do anything other than move in a straight line, it’s probably time to find a good surgeon. While the other knee ligaments might heal on their own, the ACL has poor blood circulation and is unlikely to do so.

“I have so many parents ask me, ‘If this were your child, would you go through with the surgery?’ ” said Fred Azar, an orthopedic surgeon in Memphis and vice president of the American Academy of Orthopedic Surgeons. “I always tell them: I have two teenagers and, yes, I’d get the surgery for them. It’s too hard to return to your normal level of activity without an intact ACL.”

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Young female athletes are more at risk of damaging the ACL than males when they compete in similar sports, suggests research by the National Athletic Trainers’ Association and the National Institutes of Health. Among the 989,619 patients who saw doctors for ACL injuries in 2010, about one in four were females, according to the orthopedic surgeons group. More men play sports than women, so the numbers don’t tell the whole story.

Azar said ACL surgery requires attaching a graft from another part of the body or from a cadaver, followed by a long rehab, normally about six months.

He was not involved in Griffin’s treatment, but he said his rehab this time will take longer. “RGIII had ACL surgery in 2009 on the same knee,” Azar said. “A second surgery can take eight to 12 months to heal, because it’s a more complicated surgery.”

Grafting a tendon that is thicker than the damaged ACL can give the athlete a “greater sense of stability. Some say they like it better, but it does take awhile to get used to it,” Azar said.

A tear often is diagnosed during an MRI, but surgeons don’t know the extent of the injury until they examine the inside of the knee.

After rehab, Thornton said, only a physician should give clearance for a player to return to the playing field. A national debate ensued over whether Griffin had returned to play too soon after injuring his other ligament several weeks before.

“Sometimes these injuries just happen,” Thornton said. “Had he stayed out longer to let the other injury heal, maybe it wouldn’t have happened, but it’s hard to know.”

In either case, Thornton said, parents don’t want coaches or athletes to make the decision when to return to action. “When there’s a win on the line, they don’t always have the health of the athlete in mind,” he said.